Hematologic Cancer

Overview

Hematologic malignancies develop in blood-forming tissue, such as bone marrow, or in immune system cells. Leukemia, lymphoma, and multiple myeloma are examples of hematologic cancers. It is also known as blood cancer.

Blood malignancies are classified into three categories, leukemia ( a type of cancer found in your blood and bone marrow, is caused by the rapid production of abnormal white blood cells), Lymphoma (a form of blood cancer that affects the lymphatic system, which drains excess fluids from the body and generates immune cells), Myeloma (a type of blood cancer that affects the immune system) (a cancer of the plasma cells).

Imaging examinations are commonly used to identify disease symptoms or to determine whether cancer (tumors or cell masses) has migrated to places such as the lymph nodes, chest, or lungs. Your doctor may arrange an imaging test "with contrast," which allows you to see certain organs and tissues in the body more clearly. This means that before your test, the technician will inject a contrast dye into one of your veins or a port, or you will be asked to consume a dye-containing substance. Tell your doctor or technician if you've ever had an allergic reaction to contrast dye or iodine.

 

Types of Blood Cancers

Lymphoma:

Lymphoma is a kind of cancer that develops in lymphocytes. The lymph system is a component of the immune system, which aids the body in its battle against infection and illness. Because lymph tissue may be found throughout the body, lymphoma can develop practically everywhere.

Hodgkin lymphoma and non-Hodgkin lymphoma are the two most common kinds of lymphoma (NHL). These lymphomas can affect both children and adults.

1. Non-Hodgkin's lymphoma: 

It is cancer that starts in your lymphatic system, which is part of your body's germ-fighting immune system. White blood cells called lymphocytes proliferate improperly in non-lymphoma Hodgkin's and can form tumors throughout the body.

Non- Hodgkin's lymphoma is a kind of lymphoma in general. This category has several subclasses. The most prevalent subtypes are diffuse large B-cell lymphoma and follicular lymphoma. Hodgkin's lymphoma is the other kind of lymphoma.

Advances in the diagnosis and treatment of non-lymphoma Hodgkin's have helped improve patients' prognoses.

Swollen lymph nodes in your neck, armpits, or groin are signs and symptoms of non-lymphoma. Hodgkin's Pain or swelling in the abdomen, Chest discomfort, coughing, or difficulty breathing Constant tiredness, Fever, Sweating at night, Unknown cause of weight loss.

 

2. Hodgkin's lymphoma:

 It is a form of cancer that affects the lymphatic system, which is part of the body's immune system. White blood cells called lymphocytes proliferate uncontrollably in Hodgkin's lymphoma, generating swelling lymph nodes and growths across the body.

Hodgkin's lymphoma, formerly known as Hodgkin's disease, is one of two types of lymphoma. Non-lymphoma Hodgkin's is the other.

Hodgkin's lymphoma symptoms may include painless swelling of lymph nodes in your neck, armpits, or groin, fever, persistent fatigue, sweating at night, losing weight without making an effort, itching is severe, after consuming alcohol, you may get pain in your lymph nodes.

 

Leukemia:

Leukemia is a kind of blood cell cancer. The bone marrow is where the majority of blood cells are produced. Cancerous blood cells grow in leukemia and drive out healthy blood cells in the bone marrow.

The kind of leukemia is determined by the type of malignant blood cell. Acute lymphoblastic leukemia, for example, is a lymphoblast malignancy (white blood cells that fight infection). White blood cells are the most commonly cancerous form of a blood cell. However, red blood cells (which transport oxygen from the lungs to the rest of the body) and platelets (which clot the blood) can develop cancer.

Different forms of leukemia can generate a variety of complications. Some kinds may not show any symptoms in the early stages. Symptoms that you may experience include:

• Fatigue.
• Bruising or bleeding easily.
• Fever or chills.
• Infections that are severe or keep coming back.
• Pain in your bones or joints.
• Headaches.
• Vomiting.
• Seizures.
• Weight loss.

The four main types of leukemia are:

1. Acute lymphocytic leukemia (ALL). This is the most common form of childhood leukemia. It can spread to your lymph nodes and central nervous system.
2. Acute myelogenous leukemia (AML). This is the second most common form of childhood leukemia and one of the most common forms for adults.
3. Chronic lymphocytic leukemia (CLL). This is the other most common form of adult leukemia. Some kinds of CLL will be stable for years and won’t need treatment. But with others, your body isn’t able to create normal blood cells, and you’ll need treatment.
4. Chronic myelogenous leukemia (CML). With this form, you might not have noticeable symptoms. You might not be diagnosed with it until you have a routine blood test. People 65 and older have a higher risk of this type.

 

Multiple Myeloma:

Plasma cells are immune system cells that produce antibodies that aid the body in fighting infection and disease. Plasma cell neoplasms are disorders in which the body produces an abnormal number of plasma cells in the bone marrow. The abnormal plasma cells produce M proteins, which are abnormal antibodies that accumulate in the bone marrow and can cause blood to thicken or kidney damage.

Tumors in the bone or soft tissue can also be caused by abnormal plasma cells. A plasmacytoma is a disorder that occurs when there is just one tumor. Multiple myeloma is a condition that occurs when there are multiple tumors. Both are malignant (cancer).

Multiple myeloma can go undetected for a long time and is frequently discovered when it is too late. Myeloma tumors can weaken bones, increase calcium levels in the blood, and harm the kidneys and other organs. Pain in the bones is a frequent sign of advanced multiple myeloma. Frequent infections, anemia, bleeding, numbness or tingling, and weakness are also signs and symptoms.

 

Imaging Tests to Detect Blood Cancers

Your doctor will give you specific pretest instructions. Let them know if you are or might be pregnant because many imaging tests use small amounts of radiation.

• Plain X-rays:

Images of the chest, lungs, heart, major arteries, ribs, and diaphragm are obtained by a chest x-ray. Chest x-rays are used by doctors to identify disease symptoms such as infection or malignancies. It may also exhibit indications of swollen lymph nodes or internal damage.

During the process, you will be required to wear a gown and remove all jewelry. You are positioned in front of the x-ray machine by a technician. You must hold your breath for a few seconds while the technician performs the x-ray; the technician will explain everything in detail to you. Typically, two images are taken: one from the back of the chest and one from the side. 

 

• Computed Tomography (CT) Scans:

A computed tomography (CT) scan uses numerous pictures to create a cross-section of the body. CT scans differ from ordinary x-rays in that they generate a sequence of images from various angles, resulting in significantly crisper images. A CT scan of the chest or abdomen can aid in the detection of an enlarged lymph node or malignancies of the liver, pancreas, lungs, bones, or spleen. The noninvasive test can also be used to track a tumor's response to therapy or to detect cancer recurrence following treatment.

If your abdomen is to be scanned, your doctor may prescribe laxatives, enemas, or suppositories, as well as a brief change in diet, to cleanse the colon before the scan. You may be requested not to eat or drink for many hours before the exam in some situations.

Inform your doctor or technician if you are worried about being tied down or confined in a small space. Before the exam, some patients are given a little sedative to assist them relax. If necessary, contrast dye is injected into a vein in your hand or arm before to the exam.

A CT scan typically takes 10 to 30 minutes. During the process, you will be requested to wear a gown and remove any jewelry or metal items. The technician places you on the CT test table, generally flat on your back. The table is linked to a scanner through a spherical, doughnut-shaped hole in the center. The table is swiftly moved through the scanner to identify the correct starting position. 

When the scan starts, the scanner circles around you and takes a series of images. It is critical that you remain motionless during the examination. To keep you motionless, the technician may use cushions or restraints. During the scan, you may be asked to hold and release your breath.

 

• Fluorodeoxyglucose with Positron Emission Tomography (FDG-PET):

FDG-PET (fluorodeoxyglucose plus positron emission tomography) is a powerful method for identifying lymphoma and other malignancies. The test employs a radioactive glucose (sugar) molecule known as FDG to generate pictures that depict the metabolism of your tissues (function).

 Because tumor cells require more glucose to survive and reproduce than normal cells, physicians can discover malignant cells by consuming extremely high amounts of glucose. FDG-PET can identify tumors as tiny as one centimeter in size. In addition, the exam gives a sensitive and relatively quick assessment of your reaction to therapy.

Inform your doctor or technician if you are concerned about being tied down or confined in a tiny area. Before the exam, some patients are given a little sedative to assist them relax. Fasting is normally required before to the test to ensure that your blood sugar level is not too high.

The technician injects you with FDG containing a radioactive tracer prior to the PET scan. The radioactive glucose takes 30 to 60 minutes to go through the body and be absorbed by the organ or tissue being studied. When the radioactive tracer is administered, you may feel a cool feeling creep up your arm, but there are no other adverse effects. Radiation exposure is limited.

The operation is painless and lasts around 45 minutes. During the scan, you may be requested to remove any jewelry or metal objects and wear a gown, or you may be permitted to wear loose-fitting clothing with no zippers or metal accents. The technician places you on a PET exam table that glides into a big scanner with a circular, doughnut-shaped hole in the center. It is critical that you remain motionless during the exam.

 

• Magnetic Resonance Imaging (MRI):

Magnetic resonance imaging (MRI) is a noninvasive imaging technique that produces comprehensive images of internal organs, soft tissues, blood vessels, and bones. MR pictures, which are created using a massive magnet and radio waves, can reveal disease symptoms (tumors or masses of cells). MRI can also identify bone abnormalities, which are frequent in some cancers such as myeloma, earlier than standard x-ray scans.

Inform your doctor or technician if you are concerned about being tied down or confined in a tiny area. Before the exam, some patients are given a little sedative to assist them relax. Another alternative is to perform the exam on an open MRI machine. If necessary, contrast dye is injected into a vein in your hand or arm before to the exam.

The procedure is painless and takes anywhere from 15 to 45 minutes, depending on the region being examined. During the process, you may be requested to remove any jewelry or metal objects and wear a gown, or you may be allowed to wear loose-fitting clothing with no zippers or metal accessories.

The technician positions you on the MRI exam table, which slides into a machine shaped like a tunnel. It's important that you remain still during the exam. As multiple images are taken, you'll hear a series of loud knocking sounds.

 

• Positron emission tomography-computed tomography (PET-CT) Scans:

This treatment combines PET and CT imaging techniques. During a single imaging session, a PET-CT scan gives information on the structure and function of cells and tissues in the body. It gives a more detailed picture of where the cancer is in the body than each test alone.PET and CT imaging tests are performed concurrently and in the same machine.

 

• Ultrasound:

An ultrasound, also known as sonography, creates images of internal organs, tissue, and blood flow using high-frequency sound waves. Ultrasound, unlike x-rays and computed tomography (CT) scans, does not utilize radiation. Ultrasound is used by doctors to:

1. Detect tumors, organ damage following illness, and other medical problems
2. Evaluate symptoms like pain, swelling, and infection

 

Radiological Features of Blood Cancer 

• Leukemia:

Plain radiograph: Leukemia frequently causes bone lesions. One of the most significant radiological findings is a metaphyseal radiolucent band. Subperiosteal new bone growth and osteolytic lesions affecting the medullary cavity and cortex are further radiographic findings. A mediastinal mass can be seen on a chest radiograph.

 

• Lymphoma:

Body CT: A CT scan of the body is used to detect anomalies in the belly, pelvis, chest, head, and neck, as well as swollen lymph nodes or organs.

CT may be utilized in some situations to accurately guide a biopsy needle into a questionable location so that a tissue sample may be retrieved and inspected under a microscope. This is known as a CT-guided needle biopsy.

PET scan: A PET scan, which employs a little quantity of radioactive material, can assist determine whether an enlarged lymph node is malignant and discover cancer cells throughout the body that a CT scan may not find. Following treatment, some lymphoma patients receive PET scanning to detect if the malignancy is responding to treatment. To obtain highly detailed pictures of the body, a PET scan is paired with a CT or MRI scan.

Bone scan: A radioactive isotope called technetium-99m is injected into a vein and travels to damaged sections of bone during a bone scan. This test is usually conducted if the patient is experiencing bone discomfort or if other tests indicate that lymphoma has spread to the bone.

MRI: An MRI scan is helpful in detecting lymphoma that has spread to the spinal cord or brain. It can be helpful in other areas of the body as well, such as the head and neck area.

 

• Multiple Myeloma:

Plain radiograph: A skeletal survey is necessary not only for the diagnosis of multiple myeloma, but also for predicting probable consequences (e.g., pathological fracture) and monitoring treatment response. Because 40% bone loss is necessary for lesion diagnosis, the skeletal survey has a high false-negative rate of 50% (range 30-70%). The great majority of lesions are lytic, strongly defined/punched out, and have endosteal scalloping where they about the cortex. Sclerotic lesions affect just 3% of people.

CT scan: With a dosage 1-2x that of a skeletal survey, whole-body low dose (WBLD) CT is more accurate than a skeletal scan, with a sensitivity of 70% and specificity of 90%. WBLD CT is also superior at assessing the likelihood of pathological fracture and the presence of extramedullary lesions in severely damaged bones.

MRI: MRI is more sensitive in detecting multiple lesions compared to the standard plain film skeletal survey and CT. Five patterns have been described :

• normal bone marrow signal.
• diffuse involvement.
• focal involvement.
• combined diffuse and focal involvement.
• variegated ("salt and pepper").

Bone scintigraphy: The appearance of bone scans in individuals with disseminated multiple myeloma varies due to a possible absence of osteoblastic activity. Greater lesions may be hyperactive (hot) or photopenic (cold). Bone scans may be normal as well. As a result, because the sensitivity of identifying lesions is lower than that of a plain film skeletal survey, bone scans typically do not add important information to the workup of patients with suspected or established disseminated multiple myeloma.

FDG PET-CT: FDG PET-CT is effective in identifying the distribution of disease. F-18 FDG uptake by the myeloma lesions corresponds to lytic bone lesions or soft tissue plasmacytomas seen on CT. However, focal high FDG uptake in the bone may be considered a positive lesion even in the absence of osteolysis on CT.

 

Conclusion

The majority of blood cancers, also known as hematologic malignancies, begin in the bone marrow, where blood is created. Blood cancers develop when abnormal blood cells begin to proliferate uncontrollably, interfering with the function of normal blood cells, which fight infection and make new blood cells.

Leukemia, lymphoma, and myeloma are the three main types of blood and bone marrow cancer. Leukemia is a blood cancer that develops in the blood and bone marrow and occurs when the body produces an abnormally large number of white blood cells. Lymphoma is a blood cancer that develops in the lymphatic system from cells called lymphocytes, a type of white blood cell that helps the body fight infections. Multiple myeloma is a kind of blood cancer that starts in the plasma cells, which are white blood cells generated in the bone marrow.

Some kinds of blood cancer benefit more from imaging scans than others. A scan may detect an enlarged lymph node, a frequent indication of lymphoma, but it is seldom used to diagnose leukemia, a blood malignancy that does not generate visible lesions. Scanners, however, may be useful in determining whether cancer has spread to other regions of the body.

Computed tomography (CT) scan, Magnetic resonance imaging (MRI), Positron emission tomography (PET) scan, X-ray, and Ultrasound are all examples of radiological scans.